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    Evaluation and Management of Blepharoptosis. Facial plastic surgery : FPS Drooping of the upper eyelid margin, aka blepharoptosis or "ptosis", is common. Whether the ptosis is severe or mild, congenital or acquired, aponeurotic or neuropathic or myopathic, proper management always begins with a detailed history and evaluation of the patient. The information gathered will direct the surgeon in choosing the technique most likely to give the best result. This article will briefly review common causes of ptosis, the evaluation of the ptosis patient as well as the two most common types of surgical intervention. 10.1055/a-1868-0986
    Uses of eye drops in dermatology, literature review. The Journal of dermatological treatment Since medication absorption through the skin and eye tissue seems similar, commercially available eye-drops could be used to treat skin diseases when topical therapies are unavailable or unaffordable. The FDA-approved and off-label applications of various eye drops used as topical treatments in dermatological clinical practice were highlighted in this review. A thorough PubMed and Google Scholar library search using various combinations of the keywords (Eye drop, ocular solution, conjunctival installation, and skin diseases, topical, local, beta-blockers, prostaglandin, cyclosporin, apraclonidine, atropine, oxymetazoline). Based on the findings of the studies reviewed, timolol is highly recommended for infantile hemangioma and other vascular skin conditions such as angiomas, Kaposi sarcoma, acne, rosacea, and wound healing. Bimatoprost is a drug that can be used to treat hypotrichosis of any kind, as well as mild localized alopecia areata and leukoderma. Oxymetazoline ispromising for treating facial erythema. We recommend apraclonidine for mild upper eyelid ptosis induced botulinum neurotoxin. We don't recommend atropine for hyperhidrosis, although it can help with hydrocystomas and pruritis produced by syringomas. Tobramycin will need to be tested in RCTs before it can be confirmed as a viable alternative to systemic treatments for treating green nail syndrome. 10.1080/09546634.2022.2079598
    Is It Worth Using Botulinum Toxin Injections for the Management of Mild to Moderate Blepharoptosis? Aesthetic surgery journal BACKGROUND:Mild ptosis can be aesthetically displeasing for patients, especially in unilateral cases. However, some patients do not desire to undergo a surgical repair. Botulinum toxin injection might be an option in these cases. OBJECTIVES:To objectively examine the effects of botulinum neurotoxin A (BoNT-A) injection into the orbicularis oculi muscle in the management of blepharoptosis. METHODS:In this prospective study, 8 patients with mild to moderate ptosis received application of BoNT-A in the pretarsal orbicularis oculi muscle. Standardized photographs were obtained at baseline, 2, 4, and 24 weeks. A digital image analysis software (Image J) was used for objective analysis. Primary outcomes were the margin reflex distance -1 (MRD-1) and qualitative changes on a 4-point scale. RESULTS:A significant increase in the MRD-1 on the treated side (baseline: 2.00 ± 1.13 mm; week 2: 2.52 ± 1.13mm; p=0.003) and a significant reduction (baseline: 3.23 ± 0.92 mm, week 2: 3.07 ± 0.96; p= 0.0268) on the contralateral eyelid were observed at week 2. After 24 weeks, the effect of BoNT-A diminished, and a significant difference from the baseline was not observed in both eyelids. Subjectively, 87.5% of the patients reported improvement in their eyelid ptosis. CONCLUSIONS:Botulinum toxin injection in the pretarsal orbicularis oculi muscle can be an option to temporarily manage ptosis in patients who do not desire to undergo a surgical procedure. This alternative treatment can also be used to manage temporary ptosis induced by botulinum toxin diffusion to the levator aponeurosis. 10.1093/asj/sjac139
    Frontalis suspension by a minimally invasive "harvesting-stripping technique" for congenital blepharoptosis in children under 3-years-old. European journal of ophthalmology PURPOSE:To describe a minimally-invasive "harvesting-stripping technique" on a small segment of autogenous fascia lata (AFL) in small children with severe blepharoptosis under 3-years-old. METHODS:A single-surgeon, uncontrolled surgical trial was designed for 25 eyelids of 18 small children (5 girls, 13 boys) with severe blepharoptosis. Single- and short-skin incisions (2-cm) were made on the thigh and a final 3X0.6-cm or 3.5X1-cm AFL segment was excised according to the ptosis laterality. The surface area of the harvested AFL was calculated and dissected for a final 9-cmX2-mm-long fascial strip for each eye. Functional and aesthetic outcomes of the upper eyelids were evaluated and the feasibility, effectivity and advantages of this novel approach in younger patients were assessed. RESULTS:The mean age was 28.3 months (17-35) with a mean follow-up of 34.3 months (6-96). All eyelids achieved good or excellent functional and aesthetic results (except one), with no peri- or post-operative severe complications such as haemorrhage, wound infection, hypertrophied thigh scar, muscle prolapses, eyelid contour abnormalities, ptosis recurrence or overcorrection. CONCLUSIONS:"Harvesting-stripping technique" with the AFL may be an alternative approach to correct severe upper blepharoptosis in small children under 3-years-old, which offers various benefits over conventional methods with non-autogenous materials. 10.1177/11206721221106133
    Low probability of myasthenia Gravis in patients presenting to neuro-ophthalmology clinic for evaluation of isolated ptosis. European journal of ophthalmology BACKGROUND:Concerning causes of ptosis, most notably third nerve palsy and Horner's syndrome, can be ruled out with normal ocular motility and pupillary examination. Myasthenia gravis (MG) however, rarely can present with ptosis as an isolated finding. We reviewed all patients presenting to tertiary neuro-ophthalmology practice with ptosis of unknown etiology to determine the frequency of MG. METHODS:Retrospective chart review of patients referred to a tertiary neuro-ophthalmology practice with undifferentiated ptosis. RESULTS:Sixty patients were included in the study. Twenty eight (47%) patients had ptosis along with various abnormalities of ocular motility and/or alignment and 32 (53%) had isolated unilateral ptosis defined as ptosis with absence of diplopia, or symptoms of generalized MG (GMG). Final diagnosis was aponeurotic ptosis due to levator palpebrae dehiscence in the majority (73%) of patients, while 10 (17%) were diagnosed with MG (6 with OMG, 4 with GMG). Diplopia was present in 9/10 patients with MG and 8/10 had abnormal ocular findings on clinical examination such as orbicularis oculi weakness, Cogan's lid twitch or fatiguability of ptosis on sustained upgaze. Only one patient referred for isolated unilateral ptosis was diagnosed with OMG and this patient had orbicularis oculi weakness. CONCLUSIONS:None of the patients with isolated unilateral ptosis and otherwise normal examination had MG. All patients eventually diagnosed with MG had diplopia or orbicularis weakness on examination. Thus, the yield of investigating patients with isolated ptosis for MG is exceedingly low. 10.1177/11206721221107300